Serial Number______/___-___ (Financial Year).

Range Division Commissionerate FORM CT-1 Certificate for procurement of excisable goods for export without payment of duty This is to certify that, (1) The exporter has furnished a Bond in Form [Specific/General]* for Rs___________________, which has been accepted by the Assistant Commissioner of Central Excise/the Deputy Commissioner of Central Excise in F.No. _______________________ on the _________day of the ___________(month) ___________ (Year). OR Mr./Messers. ______________________________(Name and address) is/are registered under rule 9 of Central Excise (No.2) Rules, 2001 in this Range, having registration number__________________________________has furnished an undertaking in the form specified under Notification No. /2001-Central Excise (N.T.) dated to the Assistant Commissioner of Central Excise/the Deputy Commissioner of Central Excise, _____________________(Name of the Division or the Office) who has accepted the undertaking in F.No. _______________________ on the _________day of the ___________(month) ___________ (Year). (2) The above-said exporter/manufacturer-exporter is permitted to obtain excisable goods for export under rule 19 of the Central Excise (No.2) Rules, 2001 as per details specified overleaf. This certificate is valid upto one year from the date of issue specified below. Name and Signature of the Superintendent of Central Excise ["Seal"] Dated: (Address of the RangeOffice)

(To be printed overleaf) To be filled by the exporter For Procuring Goods under the procedure specified under Notification No. 42/2001-Central Excise (N.T.) dated 26th June, 2001 issued rule 19 of the Central Excise (No.2) Rules, 2001 Name and address of the factory/ ___________________________________ warehouse/place of storage of the supplier ___________________________________ Registration Number of the factory/warehouse _________________________________ Details of the goods to be procured Sl. Description No.

Quantity

Value

Duty involved

I hereby declare that I have made a provisional debit of Rupees ............................................. (in both words and figures) in the Bond Account at serial No.................................. dated and on this day and after the abovementioned debit, the balance in the Bond Account is Rs. ... . OR Please find attested copy of the specific bond/Undertaking details of which is specified by the Superintendent of Central Excise,_____________________________ (address) overleaf. ( Dated signature of the Exporter(s) or his/ their authorised agents and their seal.

Monthly Return in terms of Para 4 (ii) of this notification

S.No.

Description of specified goods

Opening balance (3)

Received

(1)

(2)

(4)

Details Total of columns (3) & (4) (5)

Quantity exported

Closing balance

(6)

(7)

Note.- Separate entries should be made for each variety or class of goods used. I/We declare that I/we have compared the above particulars with the records (and) /books of my/our factory and that they are, insofar as I/we can ascertain complete. Verified

Date : Place: Signature of DTA exporter Name in capital letters Seal